Medical Revenue Services : Everything to know about

The main backbone of hospital’s or clinic’s business is Revenue. Medical Revenue Services play an an important role here. Services include the revenue cycle management, medical billing, charge capture etc. These services help in smooth operation of these hospitals. These services are now mainly handled using software programs specifically designed for hospitals to manage all incoming payments from insurance companies while maintaining a control over them.

What exactly is Medical Revenue Services?

The Medical Revenue Services mainly help the provider groups, hospitals and different practices with the revenue management. Providers or hospitals are also expert in giving treatment to patient but not in collecting or receiving money from the insurance companies or payer group. The best thing about these services is they will help you get the correct or right amount of money from these payer group and will also keep the patient’s need happy and healthy. Their are different steps in the revenue cycle which we will discuss one by one.

 

Medical Revenue Services : Everything to know about

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Read also: List of Revenue Codes for Medical coders

Registration

Registration solidifies the process of ensuring the patient’s information is 100% accurate from start to finish. During registration, the provider makes sure the patient’s address, phone number, date of birth, guarantors, and insurance information are correct, and it’s critical they secure this data each time a patient is treated.

Role of Medical Billing and Medical coding

Medical billing is the process of submitting and following up on claims with health insurance companies in order to receive payment for services rendered by a healthcare provider or medical billing company (interaction between a health care provider and the insurance company (payor).

Medical coder reviews the medical records and assign the appropriate CPT codes, ICD-10 codes, HCPCS codes based on the documentation. The CPT codes are the procedure codes, and has a particular dollar value. The Provider is paid based on the service or the procedure performed, which is denoted by a  CPT code. For example, if a Provider does a Ultrasound abdomen, completed exam then a CPT code 76700 will be billed on the medical claim. Now, the dollar amount of 76700 will be paid to the provider once the claim get approved or cleared by the payer or insurance company. These all services are included in revenue cycle management (RCM).

Coding is a small, but essential part of the revenue cycle, and often the most daunting. From ICD-10 to changing payer trends there is a lot to take your focus away from your primary concern – the patient.

Their are different levels in Revenue Cycle management like Charge capture, Charge entry and Bill review for full verification of the process.

Read also: Medical Billing Terminology and Glossary

               

Charge Capture is a service where an electronic charge capture process is utilized.  This involves submitting a patient’s information, such as billing data and treatment type before the patient arrives for their appointment. It is important to have accurate and up-to-date billing records in order to ensure that patients are being billed appropriately. Charge capture can be automated, where the information automatically flows into the practice management billing side based on what the provider puts in their documentation. The other option is the old-fashioned way, where front desk staff enter information or send it to billing, where it’s manually keyed in.

Charge Entry service include a medical provider entering charges into the new system once they have reviewed the bill for accuracy and is within healthcare industry regulations. Any necessary adjustments will need to be made on the computer screen before charges can be submitted electronically.

Bill Reviewing services include the Insurance verification and review process done by a medical provider before charges are submitted electronically. Once this has been completed, charges should be able to be filed within 15 minutes of entry. This process should also include checking for any errors.

Read also: What does EOB means in Medical Billing

Charge Audit

Charge Audits help reveal causes for variances including problems with charge entry, provider absences, failure of providers to report timely charges, a change in coding patterns, services not billed for, and other reasons for claim denials. Ideally, charges should be consistent from month-to-month; barring changes in physician productivity due to unavailability.

Claim processing

Any sort of claims denials and rejections will add up to lost revenue for the healthcare center. Undue delays in reimbursements also affect the cash flow. To combat these issues, it is critical that each step of the workflow is benchmarked for accuracy and better processing. Complete staff including providers, front desk, billing staff, coders and clinical staff are trained for understanding their role in claims processing.

Denial Management Services

Denial Management is one of the most important pieces of a health Revenue Cycle. When insurance companies are denying an average of 9% of claims submitted, in order to ensure a health cash flow, healthcare organizations need to focus mainly on root cause and denial prevention.

Accounts Receivable

AR is an important piece of the revenue cycle. Leverage time-tested best practices, and a proven process to collect payments and reduce AR backlogs. Your result is more money getting collected faster.

Payment Collection

The final step of the RCM cycle is the receipt of payments. Receiving payments is pivotal to the business existence and any denials may be informed by ERA. The Claims processing cycle is cumbersome and having a proficient RCM partner can make things hassle-free.

Conclusion

Medical Revenue services is very important for proper cash flow and payment to the providers and the hospitals. All the levels involved in these services helps in right amount of payment with no revenue loss to either patient or provider.The accuracy of Medical revenue services depends on these  steps of RCM cycle. Once the claim is processed successfully, then the payment will also be done smoothly. Its like accuracy is directly proportional to the right amount of payment. More accuracy will give more accurate money to the providers from the payers or insurance companies.

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